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The endoluminal functional luminal imaging probe (EndoFLIP) is a new and expanding area of medical technology. Currently its use is focused on investigating the function and motility of hollow organs of the gastrointestinal system, in the oesophagus, pylorus and rectum. 1 This study aims to retrospectively review the use of pylorus endoFLIP in children referred for symptoms of impaired gastric drainage in a single centre.We retrospectively reviewed all patients (22) who underwent pylorus endoFLIP at a single centre between July 2022 and May 2024. Demographic data, indications, weight before and after, endoFLIP measurements, interventions received (botulin toxin injection into the pylorus) and symptoms after intervention were collected.Of the included patients, there was an average age of 9 years and 5 months, and 32% were female. The percentage for each indication was: 90.91% vomiting, 68.18% retching, 13.64% abdominal distention, 54.55% intolerance to feeds and 22.73% pain after feeding.11 patients received intrapylorus botox due to abnormal endoFLIP values. The group that received botox had an average age of 8 years and 7 months. The percentage of symptoms prior to and few months after botox injection were: vomiting (100% improved to 63.6%), retching (81.8% to 54.6%), abdominal distention (18.2% to 18.2%), intolerance to feeding (54.6% to 45.5%) and pain after feeding (27.3% to 36.4%). The average weight before and after was 22.88 kg before and 23.30 kg after intervention.11 patients did not receive intrapylorus botox (due to normal endoFLIP measurements). They had an average age of 10 years and 4 months. The percentage indications were: 81.82% vomiting, 54.55% retching, 9.09% abdominal distention, 54.55% intolerance to feeding, 18.18% pain after feeding. Weight before was 26.82 kg and after was 26.04 kg. The table 1 below displays the results of both intrapylorus botox and no botox, for diameter, compliance, pressure and distensibility.Abstract OC67 Table 1Diameter, compliance, pressure and distensibility from endoFLIP in intrapylorus botox and no botox Balloon Volume (ml) Mean Diameter (mm) SDDiameter Mean Compliance (mm3/mmHg) SDCompliance Mean Pressure (mmHg) SDPressure Mean Distensibility (mm2/mmHg) SDDistensibility 20 9.02 2.31 151.98 97.22 13.57 7.81 5.33 4.48 7.38 2.01 93.39 64.64 14.97 5.13 2.30 0.86 30 10.48 2.25 120.43 46.30 17.79 3.49 4.39 2.00 8.72 1.91 82.07 37.12 24.28 13.57 2.82 1.41 40 14.23 2.77 131.08 59.99 35.44 7.21 4.90 2.39 11.78 0.85 73.97 19.26 44.92 13.61 2.69 0.96 50 14.70 1.88 83.94 29.48 62.36 9.10 2.90 1.14 13.22 1.38 197.95 211.97 53.38 28.92 3.70 2.51 White box = no intervention, yellow box = intrapylorus botoxIn conclusion, EndoFLIP is a promising tool in investigating pylorus dysfunction and symptoms of impaired gastric drainage. EndoFLIP can also be used to predict clinical response to intrapylorus botox injection.Reference Hirano I, Pandolfino JE, Boeckxstaens GE. Functional lumen imaging probe for the management of esophageal disorders: expert review from the clinical practice updates committee of the AGA institute. Clinical Gastroenterology and Hepatology 2017 Mar;15(3):325–34.